PO-02-065 CATHETER ABLATION WITH TERMINATION OF PERSISTENT ATRIAL FIBRILLATION USING SPATIOTEMPORAL DISPERSION

Abstract

Several strategies of electrogram (EGM) guided catheter ablation of atrial fibrillation (AF) have been previously described. A spatiotemporal dispersion (SD) ablation strategy targeting AF drivers with very high termination rates has been reported; however, these sites have not been well characterized. The purpose of this study is to validate the prior experience with SD ablation in the persistent AF cohort and further characterize the regions of AF termination. Consecutive patients with persistent AF undergoing radiofrequency catheter ablation were included. Electroanatomic mapping of SD areas was performed during AF. Ablation was delivered initially at sites of continuous SD, followed by pulmonary vein isolation in all patients. If AF did not terminate, additional regions of intermittent SD were ablated. If AF terminated to atrial tachycardia or flutter, additional electroanatomic mapping and ablation was performed to achieve sinus rhythm. Representative EGMs at sites of continuous SD, intermittent SD, and no SD are shown in Figures 1A, 1B, and 1C, respectively. Left atrial (LA) volume and surface area, termination sites, and procedural characteristics are reported. A total of 20 consecutive patients (13 male, 67 ± 9 years) with persistent AF (median time from diagnosis 5 years) undergoing ablation were included in the study. The majority of continuous SD was seen on the anterior wall (18/20 patients) and septum (15/20 patients) and occasionally on the posterior wall (8/20 patients). 17/20 (85%) patients successfully terminated to sinus rhythm during the procedure. The majority of the termination sites were on the septum and anterior wall (12/17) with none on the posterior wall. LA volume by echocardiography was smaller in the termination group (84 vs. 105 mL, p < 0.01) and fluoroscopy use was less in the termination group (2.3 vs. 4.8 min, p = 0.03). There was no difference in ejection fraction, LA surface area, radiofrequency time, or procedure time (p = NS). A very high termination rate of persistent AF was achievable with ablation of SD regions. These regions likely represent drivers of AF and seem to localize predominantly on the septum and anterior wall of the LA, and rarely on the posterior wall. Ablation incorporating SD mapping may allow for patient-tailored approach to AF ablation.